Ghahremani G G, Crampton A R, Bernstein J R, Caprini J A
Department of Diagnostic Radiology, Evanston Hospital, McGaw Medical Center of Northwestern University, IL 60201.
Radiographics. 1991 May;11(3):441-56. doi: 10.1148/radiographics.11.3.1852936.
Thirteen intrahepatic and 22 extrahepatic biliary tract complications were detected radiologically in 35 adult patients who had undergone cholecystectomy and bile duct exploration. Intraoperative usage of Fogarty balloon catheters to extract biliary calculi without fluoroscopic guidance resulted in focal ectasia or rupture of intrahepatic radicles in two and seven cases, respectively. Metallic surgical instruments such as Bakes dilators and biliary forceps or clamps accounted for most of the common duct injuries; these were manifested as submucosal dissection (two cases), transmural laceration (four cases), or localized trauma with subsequent stricture (three cases). Technical mishaps during T-tube placement led to common duct perforation (four cases) and extraluminal malposition of T tubes (three cases). The remaining complications included choledochoduodenal fistula (three cases), biliovenous fistula (two cases), biloma (three cases), and retained intraductal fragments of biliary drainage catheters (two cases). Knowledge about radiologic features and causal factors of such iatrogenic processes can play a crucial role in their prevention, correct diagnosis, and management.
在35例接受胆囊切除术和胆管探查术的成年患者中，经放射学检查发现13例肝内和22例肝外胆道并发症。术中在无荧光透视引导下使用Fogarty球囊导管取出胆管结石，分别导致2例和7例肝内胆管分支局部扩张或破裂。诸如Bakes扩张器、胆道钳或夹子等金属手术器械是造成胆总管损伤的主要原因；表现为黏膜下剥离（2例）、全层撕裂（4例）或局部创伤伴随后狭窄（3例）。放置T管期间的技术失误导致胆总管穿孔（4例）和T管管腔外位置异常（3例）。其余并发症包括胆总管十二指肠瘘（3例）、胆静脉瘘（2例）、胆汁瘤（3例）和胆管引流导管导管内碎片残留（2例）。了解此类医源性过程的放射学特征和病因在其预防、正确诊断和处理中起着至关重要的作用。
